Upfront surgery for N2 NSCLC: a large retrospective multicenter cohort study

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Oncology

Background:

• Optimal treatment sequencing for N2 non-small cell lung cancer (NSCLC) is not well-defined.
• Current treatment strategies involve surgery, chemotherapy, and radiotherapy in various combinations.
• N2 NSCLC involves metastasis to mediastinal lymph nodes.

Purpose of the Study:

• To compare the efficacy of induction chemotherapy followed by surgery versus upfront surgery with adjuvant treatment in N2 NSCLC patients.
• To evaluate recurrence rates, overall survival (OS), and disease-free survival (DFS) between the two treatment approaches.

Main Methods:

• Retrospective review of 405 patients with N2 NSCLC between 2010 and 2016.
• Patients were divided into an Induction Group (neoadjuvant chemotherapy) and an Upfront surgery Group.
• Propensity score-matched (PSM) analysis included 52 patients in each group.

Main Results:

• No significant differences in general characteristics, perioperative outcomes, or complication rates were observed between groups.
• Recurrence rates (57.7% vs 50.0%), OS (40.98±35.78 vs 37.0±40.69 months), and DFS (29.67±36.01 vs 27.96±40.08 months) were similar.
• pT stage and skipping lymph node metastasis were identified as independent predictors for OS.

Conclusions:

• Upfront surgery followed by adjuvant therapy is not inferior to induction chemotherapy with subsequent surgery for N2 NSCLC.
• The choice of treatment sequence may not significantly impact key survival outcomes.
• Further research may refine treatment algorithms for N2 NSCLC.